Brett D Owens

Keller Army Community Hospital, ვესტ-პოინტი, New York, United States

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Publications (171)364.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Determining the magnitude of glenoid bone loss in cases of shoulder instability is an important step in selecting the optimal reconstructive procedure. Recently, a formula has been proposed that estimates native glenoid width based on magnetic resonance imaging (MRI) measurements of height (1/3 × glenoid height + 15 mm). This technique, however, has not been validated for use with computed tomography (CT), which is often the preferred imaging modality to assess bone deficiencies. The purpose of this project was 2-fold: (1) to determine if the MRI-based formula that predicts glenoid width from height is valid with CT and (2) to determine if a more accurate regression can be resolved for use specifically with CT data. Descriptive laboratory study. Ninety normal shoulder CT scans with preserved osseous anatomy were drawn from an existing database and analyzed. Measurements of glenoid height and width were performed by 2 observers on reconstructed 3-dimensional models. After assessment of reliability, the data were correlated, and regression models were created for male and female shoulders. The accuracy of the MRI-based model's predictions was then compared with that of the CT-based models. Intra- and interrater reliabilities were good to excellent for height and width, with intraclass correlation coefficients of 0.765 to 0.992. The height and width values had a strong correlation of 0.900 (P < .001). Regression analyses for male and female shoulders produced CT-specific formulas: for men, glenoid width = 2/3 × glenoid height + 5 mm; for women, glenoid width = 2/3 × glenoid height + 3 mm. Comparison of predictions from the MRI- and CT-specific formulas demonstrated good agreement (intraclass correlation coefficient = 0.818). The CT-specific formulas produced a root mean squared error of 1.2 mm, whereas application of the MRI-specific formula to CT images resulted in a root mean squared error of 1.5 mm. Use of the MRI-based formula on CT scans to predict glenoid width produced estimates that were nearly as accurate as the CT-specific formulas. The CT-specific formulas, however, are more accurate at predicting native glenoid width when applied to CT data. Imaging-specific (CT and MRI) formulas have been developed to estimate glenoid bone loss in patients with instability. The CT-specific formula can accurately predict native glenoid width, having an error of only 2.2% of average glenoid width. © 2015 The Author(s).
    The American Journal of Sports Medicine 04/2015; DOI:10.1177/0363546515581468 · 4.70 Impact Factor
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    ABSTRACT: Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service. The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups. In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively). The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2015; DOI:10.1016/j.jse.2015.02.021 · 2.37 Impact Factor
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    ABSTRACT: Background: Most of the literature on shoulder instability focuses on patients experiencing anterior glenohumeral dislocation, with little known about the treatment of anterior subluxation events. Purpose: To determine the outcomes of surgical stabilization of patients with anterior glenohumeral subluxations and to compare open and arthroscopic approaches. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We prospectively enrolled patients with anterior glenohumeral subluxations undergoing surgical stabilization. Patients were offered randomization between open and arthroscopic stabilization. Inclusion criteria included patients with anterior glenohumeral subluxations undergoing Bankart repair, while exclusions included the presence of glenoid or humeral bone loss, multidirectional instability, capsular tear/humeral avulsion of the glenohumeral ligament lesion, and rotator cuff tear requiring repair. Patients were randomized to an open Bankart repair through a subscapularis takedown or an arthroscopic Bankart repair, both using the same bioabsorbable suture anchors, and they were followed for a minimum of 2 years. Outcomes were evaluated with the Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Rowe, and Tegner activity scores. Results: A total of 26 patients were enrolled, with 7 being lost to follow-up. Complete follow-up data were available on 19 subjects (74%): 10 in the open group and 9 in the arthroscopic group. There were no significant differences noted between the randomized groups, with a 2-year WOSI score of 320 in the open subjects and 330 in the arthroscopic subjects, and similar findings in the other scoring scales. There were no cases of dislocation following surgery. There were 3 patients with recurrent instability (subluxations only) in each group at a mean of 17 months, for an overall recurrent subluxation rate of 31%. These subjects with recurrence had lower outcome scores (WOSI, 532; SANE, 88.4). The outcomes of the 9 subjects with ≤3 subluxation events were superior to those of the 10 subjects with >3 events prior to stabilization. The patients with ≤3 events had a WOSI score of 143, compared with 470 (P = .042), and an ASES mean score of 98.8, compared with 87.1 (P = .048). Four of the 6 patients with recurrent subluxations had sustained >3 subluxations prior to stabilization. Conclusion: Overall, patients with Bankart lesions resulting from an anterior glenohumeral subluxation event had excellent outcomes with surgical stabilization. The overall recurrence in the 19 subjects with at least 2-year follow-up was 6 cases (31%), with no instances of dislocation in this young, active cohort. There was no significant benefit to open or arthroscopic stabilization, and we did find that stabilization of subluxation patients with ≤3 events resulted in superior outcomes compared with chronic recurrent subluxation patients with >3 events. We recommend early surgical stabilization of young athletes with Bankart lesions that result from anterior subluxation events.
    01/2015; 3(1):1-4. DOI:10.1177/2325967115571084
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    ABSTRACT: Background: Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. Objective: To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. Results: The median MARS score was significantly higher for men when compared with women (χ2 = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ2 = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ2 = 9.06, df = 1, P = 0.003). Conclusion: Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex.
    Sports Health A Multidisciplinary Approach 01/2015; DOI:10.1177/1941738115576121
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    ABSTRACT: Purpose The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration. Methods Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces. Results In vitro and in vivo studies indicate that the use of stratified scaffolds composed of multiple layers with distinct compositions for regeneration of distinct tissue types within the same scaffold and anatomic location is feasible. This emerging tissue engineering approach has potential applications in regeneration of bone defects, osteochondral lesions and tendon-to-bone interfaces with successful basic research findings that encourage clinical applications. Conclusions Present data supporting the advantages of the use of multilayer scaffolds as an emerging strategy in musculoskeletal tissue engineering are promising, however, still limited. Positive impacts of the use of next generation scaffolds in orthopaedic tissue engineering can be expected in terms of decreasing the invasiveness of current grafting techniques used for reconstruction of bone and osteochondral defects, and tendon-to-bone interfaces in near future.
    Knee Surgery Sports Traumatology Arthroscopy 12/2014; DOI:10.1007/s00167-014-3453-z · 2.84 Impact Factor
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    ABSTRACT: There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability, and limited data are available to guide return to play.
    The American Journal of Sports Medicine 11/2014; DOI:10.1177/0363546514553181 · 4.70 Impact Factor
  • Brett D Owens
    The American Journal of Sports Medicine 11/2014; 42(11):2557-9. DOI:10.1177/0363546514556637 · 4.70 Impact Factor
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    ABSTRACT: A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.
    HSS Journal 10/2014; 10(3):208-12. DOI:10.1007/s11420-014-9404-x
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    ABSTRACT: Snapping scapula syndrome is a rare condition that presents with symptoms ranging from crepitus to disabling pain in the scapulothoracic articulation. This condition may be more frequent in a military population because of physical fitness standards that require nonphysiologic forces to be applied to the scapulothoracic articulation. Nonoperative therapy is the first-line management. Surgical options include arthroscopic or open scapulothoracic bursectomy with or without partial scapulectomy. After scapulothoracic arthroscopy up to 90% of patients report good/excellent results, up to 90% are able to return to work, and more than 60% return to sports.
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.06.003 · 2.58 Impact Factor
  • Brett D. Owens
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.07.001 · 2.58 Impact Factor
  • Article: Dedication
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.07.002 · 2.58 Impact Factor
  • Kenneth L. Cameron, Brett D. Owens
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    ABSTRACT: Because of the volume of sports-related musculoskeletal injuries experienced by military service members, the US Department of Defense has begun to implement the sports medicine model of care to improve the access, efficiency, and effectiveness of care for solders who experience musculoskeletal injuries related to sports and training. In this article, the burden of musculoskeletal injuries and conditions related to sports and physical fitness training within the military is reviewed, and the application of the sports medicine model to care for these injuries in military service members is described.
    Clinics in Sports Medicine 10/2014; 33(4):573–589. DOI:10.1016/j.csm.2014.06.004 · 2.58 Impact Factor
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    ABSTRACT: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injury are poorly understood.
    09/2014; 42(11). DOI:10.1177/0363546514551149
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    ABSTRACT: There has been increased interest in the number of concussions occurring in college football over the past year. In April 2010, the National Collegiate Athletic Association (NCAA) published new guidelines for the diagnosis and treatment of concussions in student athletes.
    Sports Health A Multidisciplinary Approach 09/2014; 6(5):402-5. DOI:10.1177/1941738113491545
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    ABSTRACT: Military personnel have a greater risk of developing osteoarthritis (OA) than the general population. OA is a chronic, painful, and debilitating disease with a high cost burden. Compared with the general population, a higher prevalence of post-traumatic OA has been reported in the military. Using recent literature, we aim to improve the understanding of post-traumatic OA, with an exploration of the pathophysiology of OA. Our review encompasses the current treatment modalities for alleviating the pain from OA with a focus on viscosupplementation. A multimodal approach may be beneficial for the relief of OA pain and improvement of function in military personnel with early OA, and may lower the cost burden.
    Military medicine 08/2014; 179(8):815-820. DOI:10.7205/MILMED-D-14-00052 · 0.77 Impact Factor
  • 08/2014; 2(2 Suppl). DOI:10.1177/2325967114S00023
  • Source
    AOSSM Annual Meeting, Seattle, WA; 07/2014
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2014; 30(6):e2. DOI:10.1016/j.arthro.2014.04.011 · 3.19 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2014; 30(6):e35-e36. DOI:10.1016/j.arthro.2014.04.076 · 3.19 Impact Factor
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    ABSTRACT: Background: Bone block length for bone–patellar tendon–bone (BPTB) anterior cruciate ligament (ACL) reconstruction has traditionally been 25mm in length. The previous surgical technique did not require the surgeon to pay particular attention to the length of the bone block, and therefore, there is scant evidence in the literature describing ideal lengths. With the gaining popularity of accessory medial portal drilling of the femoral tunnel, concerns with tunnel length and graft shuttling have surfaced. Newer techniques have advised shortening of the femoral bone block to accommodate the shorter tunnel and for ease of bone block manipulation into the aperture of the tunnel. Purpose: To compare the effects of bone block length on the pull-out strength of patellar tendon grafts using metal interference screws in a porcine ACL reconstruction model. The hypothesis was that the pull-out strength of each length of bone block under cyclic and ultimate load to failure testing would surpass the physiologic loads experienced by a normal ACL. Study Design: Controlled laboratory study. Methods: This study used 27 unmatched porcine femurs and BPTB constructs. Specimens were randomly assigned to a 10-, 15-, or 20-mm bone block reconstruction and a cycle load of 100, 500, or 1000 cycles. This resulted in 9 specimen groups with 3 specimens in each group. A central composite design (CCD) for the test matrix was selected, as this was optimum for requiring relatively few experiments while still exploring the complete range of interest for 2 independent variables. Each reconstruction used a 7 � 20–mm titanium interference screw. All reconstructions were performed on the femoral side using 10-mm-wide patellar tendon grafts, and tensile tests were performed. The loading protocol started with a 20-N preload, then cyclic testing to the appropriate number of cycles in the elastic region between 50 and 150 N at a strain rate of 200 mm/min, and then ended with ultimate load-tofailure testing. Ultimate load to failure, peak stress, elongation, and stiffness were all recorded. The patellar tendon graft mode of failure was measured by visual inspection. Results: During load-to-failure testing, 5 of 9 graft constructs in the 10-mmgroup failed at the bone block, while 2 of 9 failed in the 15- mm group at this interface. In the 20-mm group, all 9 specimens failed at the tendon, and none failed at the bone block. There was a statistically significant difference in modes of failure between the bone block length groups in the reconstructed ACL grafts. Analysis indicates that a smaller bone block length graft ismore likely to fail due to a bone block failure than a tendon failure. The average ± standard deviation failure load for all specimenswas 573 ± 171 N.Themean failure loads for the 10-, 15-, and 20-mmgroupswere 614 ± 110, 658 ± 92, and 540 ± 203 N, respectively. There was no statistical significance between the groups in any of these measurements. Conclusion: Bone blocks of 20 to 25mmin length are normally used in surgical practice. Thus, the purpose of this studywas to explore the effects of asmaller boneblock length in the fixation strength of a graft. This study couldnot yielda significant difference in failure load for differently sized bone blocks. There was a significant tendency of shorter bone block lengths to fail due to bone block failure. Clinical Relevance: Bone block failure was defined as slippage of the bone block or interference screw. These results show that using a smaller bone block may increase the likelihood of a graft failure in an ACL reconstruction. Keywords: ACL reconstruction; BTB autograft; interference screw fixation
    05/2014; 2(2). DOI:10.1177/2325967114532762

Publication Stats

2k Citations
364.21 Total Impact Points

Institutions

  • 2006–2015
    • Keller Army Community Hospital
      ვესტ-პოინტი, New York, United States
  • 2014
    • Uniformed Services University of the Health Sciences
      베서스다, Maryland, United States
  • 2008–2014
    • United States Military Academy
      West Point, New York, United States
  • 2008–2013
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2009–2012
    • University of Colorado
      • Department of Orthopaedics
      Denver, Colorado, United States
    • United States Army
      Washington, West Virginia, United States
  • 2007–2012
    • Tripler Army Medical Center
      Honolulu, Hawaii, United States
  • 2001–2012
    • Walter Reed National Military Medical Center
      • Division of Orthopaedic Surgery
      Washington, Washington, D.C., United States
  • 2010
    • The University of Arizona
      • College of Medicine
      Tucson, AZ, United States
  • 2006–2007
    • U.S. Army Institute of Surgical Research
      Houston, Texas, United States
  • 2001–2007
    • University of Massachusetts Medical School
      • Center for Outcomes Research
      Worcester, Massachusetts, United States
  • 2003
    • University of Massachusetts Amherst
      Amherst Center, Massachusetts, United States
    • Dartmouth–Hitchcock Medical Center
      LEB, New Hampshire, United States